Individual
ANDREW KENNETH WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 W 38TH ST, AUSTIN, TX 78705-1006
(512) 324-1010
Mailing address
418 BRADY LN, AUSTIN, TX 78746-5502
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L2753
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147670701
—
TX
05
—
147670703
—
TX
01
—
8A6353
BCBS
TX
01
—
8A9105
BCBS
TX
Enumeration date
05/22/2006
Last updated
04/22/2008
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